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Health Bull (Edinb). 1997 May;55(3):176-84.

Coping with the inexorable rise in medical admissions: evaluating a radical reorganisation of acute medical care in a Scottish district general hospital.

Author information

  • 1Royal Alexandria Hospital, Paisley.

Abstract

OBJECTIVE:

To describe radical changes in acute medical care in a district general hospital and assess their impact on staff and patients.

DESIGN:

A before and after comparison of structure, process and outcome indicators in the year preceding and following reorganisation.

SETTING:

The Adult Medicine Clinical Directorate of the Royal Alexandra Hospital in Paisley, Scotland.

SUBJECTS:

Staff in the Medical Directorate and a random sample of 400 patients.

INTERVENTIONS:

The main stimulus for reorganisation was the pressure caused by a relatively steep rise in admissions. In response, the six existing general medical wards were converted into a 38-bed Medical Admissions Unit and five more specialised wards. A new acute receiving rota allowed each consultant to concentrate almost exclusively on acute receiving for one week at a time.

RESULTS:

The boarding of patients in non-medical wards was eliminated through improved bed management. The needs of patients became better matched to the specialism of their consultant. The cardiologist's share of in-patients with cardiological problems rose from 34% of 2,877 cases to 58% of 3,085 cases (p < 0.001) and the respiratory physicians' share of respiratory in-patients grew from 53% of 1,281 cases to 67% of 1,287 cases (p < 0.001). After the reorganisation, medical staff had significantly fewer concerns about losing track of patients (p < 0.01) or about boarding (p < 0.01), however, concern about 'blocked beds' became greater (p < 0.05). Nurses reported more time for health promotion (p < 0.01) but also a rise in stress (p < 0.05). More patients reported that staff had time to explain their treatment (85/109 (79%) before, 93/105 (89%) after, p < 0.05) and a higher proportion felt ready for discharge (91/108 (84%) before, 99/106 (93%) after, p < 0.05).

CONCLUSIONS:

Radical reorganisation of medical care in response to rising acute medical admissions is achievable and may lead to improvements in care.

PMID:
9364106
[PubMed - indexed for MEDLINE]
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